Phase-Only Rotation Invariant Correlation Using Synthesized Phase Objects

We present a development of the method of synthesized phase objects (SPO-method) (P. V. Yezhov, et al. Opt. Exp. 20, 29854 (2012)) for the phase-only rotation invariant pattern recognition. It has been performed a comparison of correlation signals for a set of amplitude objects under their rotation by using the standard and SPO methods, by applying the Fourier-Mellin transformation. The results of both calculation and optical experiments carried out using an optical-digital correlator with SLM in the Fourier plane have been presented.

Remifentanil vs. Lignocaine for Attenuating the Haemodynamic Response during Rapid Sequence Induction Using Propofol: Double-Blind Randomised Clinical Trial

This study was conducted to determine whether lignocaine or remifentanil effectively attenuate the response to endotracheal intubation during rapid sequence induction. Forty-eight patients were randomly divided into three groups: Group NS (n=16) received normal saline 0.1 ml/kg, Group L (n=16) received lignocaine 1.5 mg/kg, and Group R (n=16) received remifentanil 1 /μg/kg. Anaesthesia was induced with propofol 2 mg/kg after glycopyrrolate 0.2 mg IV. Each study drug was given intravenously over 30 seconds after loss of consciousness. Cricoid pressure was applied until intubation. Succinylcholine 1.0 mg/kg was administered to facilitate tracheal intubation. After intubation, the patient's lungs were ventilated with sevoflurane 1% and nitrous oxide 50% in oxygen. Mean arterial pressure and heart rate were recorded before induction, at loss of consciousness, immediately before laryngoscopy and every minute after intubation for 10 minutes. Mean arterial pressure fell following propofol in all groups. The maximum increase in mean arterial pressure in Group NS and Group L were 46% and 38% respectively above the baseline value one minute after intubation, whereas the mean arterial pressure in Group R increased only back to the baseline value. Heart rate in Group NS and Group L were increased by 27% and 33% above baseline value respectively one minute after intubation, while that in Group R was increased only to the baseline value. The results indicate that remifentanil 1 μg/kg, but not lignocaine 1.5 mg/kg, effectively attenuates the haemodynamic response to endotracheal intubation during rapid sequence induction using propofol.

Acute Basilar Artery Occlusion: Differences in Characteristics and Outcomes after Endovascular Therapy between Patients with and without Underlying Severe Atherosclerotic Stenosis

BACKGROUND AND PURPOSE

Prediction of underlying intracranial atherosclerotic stenosis before endovascular therapy might be helpful for appropriate therapeutic planning in patients with acute ischemic stroke. This study aimed to compare the characteristics and treatment outcomes in patients with acute basilar artery occlusion relative to the existence or nonexistence of underlying intracranial atherosclerotic stenosis.

MATERIALS AND METHODS

Sixty-two patients with acute basilar artery occlusion underwent multimodal endovascular therapy. All patients underwent stent-retriever thrombectomy as a first-line endovascular therapy. Patients with underlying intracranial atherosclerotic stenosis underwent additional intracranial angioplasty and stent placement. The clinical and imaging characteristics and treatment outcomes were retrospectively analyzed and compared between patients with and without intracranial atherosclerotic stenosis.

RESULTS

Underlying intracranial atherosclerotic stenosis was identified at the occlusion site in 15 patients (24.1%). Occlusion in the proximal segment of the basilar artery was more common in patients with intracranial atherosclerotic stenosis (60% versus 6.4%, P < .001), whereas occlusion in the distal segment was more common in those without it (91.5% versus 26.7%, P < .001). Bilateral thalamic infarction on a pretreatment DWI was less common in patients with intracranial atherosclerotic stenosis (0% versus 27.7%, P = .027) compared with those without it. There were no significant differences in the rates of successful revascularization, favorable outcome, symptomatic hemorrhage, and mortality between the 2 groups.

CONCLUSIONS

Underlying intracranial atherosclerotic stenosis was not uncommon in patients with acute basilar artery occlusion. The occlusion segment of the basilar artery and the presence or absence of bilateral thalamic infarction on a pretreatment DWI might be helpful for predicting underlying intracranial atherosclerotic stenosis in patients with acute basilar artery occlusion. Patients with and without underlying intracranial atherosclerotic stenosis who underwent endovascular therapy had similar outcomes.

Deformation mechanisms to ameliorate the mechanical properties of novel TRIP/TWIP Co-Cr-Mo-(Cu) ultrafine eutectic alloys

In the present study, the microstructural evolution and the modulation of the mechanical properties have been investigated for a Co-Cr-Mo (CCM) ternary eutectic alloy by addition of a small amount of copper (0.5 and 1 at.%). The microstructural observations reveal a distinct dissimilarity in the eutectic structure such as a broken lamellar structure and a well-aligned lamellar structure and an increasing volume fraction of Co lamellae as increasing amount of copper addition. This microstructural evolution leads to improved plasticity from 1% to 10% without the typical tradeoff between the overall strength and compressive plasticity. Moreover, investigation of the fractured samples indicates that the CCMCu alloy exhibits higher plastic deformability and combinatorial mechanisms for improved plastic behavior. The improved plasticity of CCMCu alloys originates from several deformation mechanisms; i) slip, ii) deformation twinning, iii) strain-induced transformation and iv) shear banding. These results reveal that the mechanical properties of eutectic alloys in the Co-Cr-Mo system can be ameliorated by micro-alloying such as Cu addition.

What is the ideal interval between dressing changes during negative pressure wound therapy for open traumatic fractures?

OBJECTIVE

Negative pressure wound therapy (NPWT) is effective in infection control during treatment of severe open fractures. However frequent dressing changes during NPWT are costly and cause patient discomfort. If the interval between dressing changes could be extended, these problems would be reduced. In this article we compare the outcomes of open IIIB fractures with 3-day versus 7-day intervals between dressing changes.

METHOD

Patients who sustained Gustilo IIIB open fractures were included. All underwent conventional orthopaedic fixation with delayed latissimus dorsi flap coverage. Group 1 had 3-day intervals between dressing changes and group 2 had 7-day intervals. The final outcomes in the two groups were analysed.

RESULTS

There were 38 patients in group 1 and 34 patients in group 2. Although the period between admission and final operation was similar in the two groups, the mean number of NPWT changes was 4.54 in 3 day in group 1 and 1.95 in group 2 (p<0.001). This led to a difference in NPWT-related costs; $341.26 in group 1 and $237.49 in group 2 (p<0.001). There was no difference in the frequency of complications such as infection or non-union of fractures.

CONCLUSION

NPWT is useful treatment option for open fractures, to bridge between initial debridement and final microsurgical tissue transfer. Considering patient comfort, the costs related to the NPWT, and the final flap results, a 7-day interval between changes of the NPWT is acceptable.

Properties of an Axial Optical Vortex Generated with the Use of a Gaussian Beam and Two Ramps

The behavior of an axial optical vortex (OV), which is generated with the use of a Gaussian beam and two ramps implemented by a phase-only spatial light modulator (SLM), is studied as a function of the parameters of two ramps. The analytic solution of a wave equation is obtained in the Fresnel approximation for the diffraction of a Gaussian beam on the two-ramp structure. Nonlinear dependences of the ellipticity gamma of the intensity distribution in the OV core, as well as the angle (phi between the x-axis and the major ellipse axis of the vortex core, on the ramp phase gradient K, are analyzed. The values of given parameters obtained in optical and numerical experiments are in good agreement. It is shown that, as the gradients of the phases of two ramps vary in the limits of 3pi rad/cm, the ellipticity and the slope angle of the major axis ellipse are changed, respectively, by 0.3 and 56 degrees. This gives possibility to efficiently control the parameters of OVs.

The ossification pattern in paediatric occipito-cervical spine: is it possible to estimate real age?

AIM

To retrospectively analyse the synchondrosis from the occipital bone to the whole cervical spine and determine the feasibility and validity of age estimation using computed tomography (CT) images.

MATERIAL AND METHODS

A total of 231 cervical spine or neck CT images of young children (<7 years of age) were examined. Twelve ossification centres were assessed (occiput: n = 2; atlas: n = 2; axis, n = 6; whole sub-axial vertebra: n = 2), and the ossification process was graded as open (O, fully lucent), osseous bridging (B, partially ossified), and fusion (F, totally ossified). After the first analysis was completed, the resulting chronological chart was used to estimate the age of 10 new cases in order to confirm the usefulness of the chart.

RESULTS

Infancy was easily estimated using the sub-axial or C2 posterior ossification centres, while the posterior occipital regions provided good estimation of age between 1-2 years. The most difficult period for accurate age estimation was between 2-4 years. However, the C2 anterior (neurocentral ossification) and C1 posterior regions did yield information to help determine the age around 3 years. The anterior occipital region was useful for age estimation between 4-5 years, and the C1-anterior region was potentially useful to help decide among the other parameters. The test for age estimation (TAE) had a very high ICC score (0.973) among the three observers.

CONCLUSION

Segmentalised analysis can enhance the ability to estimate real age, at least by the year. The analysis of the occipital bone made a strong contribution to the usefulness of the chorological chart. An organised chronological chart can provide readily available information for age estimation, and the primary application of the above data (TAE) demonstrated the validity of this approach.

Retinal sensitivity assessed by microperimetry and corresponding retinal structure and thickness in resolved central serous chorioretinopathy

PURPOSE

To investigate the relationship between retinal sensitivity (RS) assessed by microperimetry (MP) and retinal structural changes in patients with resolved central serous chorioretinopathy (CSC).

METHODS

Spectral domain optical coherence tomography (OCT) examination and MP tests were performed in patients with resolved CSC. Point-to-point correlation was performed between RS and corresponding retinal structural changes using Pearson's correlation analysis. In addition, in a 1-mm zone in the central fovea, a correlation was calculated between the mean RS and the mean central retinal thickness (CRT).

RESULTS

Eighty-four eyes were analyzed. The total number of MP test points was 1092 (84 eyes × 13 points). The mean RS and retinal point thickness (RPT) of all test points were 13.53±3.84 dB and 208.6±48.0 μm, respectively. The RS and RPT were significantly decreased in the test points with loss of the ellipsoid portion of the inner segments (EPIS) (P<0.0001). Within the 1-mm foveal center zone, there was a significant correlation between mean RS and mean CRT (r=0.432, P<0.0001) and between RS and the corresponding RPT (r=0.339, P<0.0001).

CONCLUSION

RS was dependent on the status of the EPIS in patients with resolved CSC. The correlation between mean RS and mean CRT was compatible with the point-to-point correlation between RS and the corresponding RPT.

Acute basilar artery occlusion: outcome of mechanical thrombectomy with Solitaire stent within 8 hours of stroke onset

BACKGROUND AND PURPOSE

Mechanical thrombectomy with a stent retriever applied shortly after symptom onset could increase good functional outcomes and improve survival in patients with acute basilar artery occlusion, but this has not yet been studied. This study evaluated the efficacy and safety of mechanical thrombectomy with a Solitaire stent within 8 hours of stroke onset in patients with acute basilar artery occlusion.

MATERIALS AND METHODS

We analyzed 25 consecutive patients with acute basilar artery occlusion who were treated with mechanical thrombectomy by use of the Solitaire stent within 8 hours of stroke symptom onset. Successful recanalization was defined as TICI grade 2b or 3. Good outcome was defined as mRS score of 0-2 at 3 months. Clinical and radiologic data in patients with good outcomes were compared with those with poor outcomes.

RESULTS

Successful recanalization was achieved in 96% (24/25) of patients, and 48% (12/25) of patients had good outcomes. Eighty-eight percent (22/25) of patients survived to 3 months. The median NIHSS score on admission was significantly lower in patients with good outcomes than in those with poor outcomes (9.5 versus 14, P = .005). Procedure-related complications occurred in 2 patients (8%). No symptomatic intracerebral hemorrhages occurred.

CONCLUSIONS

The current study suggests that mechanical thrombectomy by use of a Solitaire stent within 8 hours of stroke onset increases good outcomes and improves survival in patients with acute basilar artery occlusion.

DoGeNetS: using optimisation to discriminate regulatory network topologies based on gene expression data

Gene regulatory networks (GRNs) determine the dynamics of gene expression. Interest often focuses on the topological structure of a GRN while numerical parameters (e.g. decay rates) are unknown and less important. For larger GRNs, inference of structure from gene expression data is prohibitively difficult. Models are often proposed based on integrative interpretation of multiple sources of information. We have developed DoGeNetS (Discrimination of Gene Network Structures), a method to directly assess candidate models of GRN structure against a target gene expression data set. The transsys language serves to model GRN structures. Numeric parameters are optimised to approximate the target data. Multiple restarts of optimisation yield score sets that provide a basis to statistically discriminate candidate models according to their potential to explain the target data. We demonstrate discrimination power of the DoGeNetS method by relating structural divergence to divergence between gene expression data sets. Known models are used to generate target expression data, and a set of candidate models with a defined structural divergence to the true model is produced. Structural divergence and divergence of expression profiles after optimisation are strongly correlated. We further show that discrimination is possible at noise levels exceeding those typical of contemporary microarray data. DoGeNetS is capable of discriminating the best GRN structure from among a small number of candidates. p values indicate whether differences in divergence of expression are significant. Although this study uses single gene knockouts, the DoGeNetS method can be adapted to simulate a virtually unlimited range of experimental conditions. [Includes supplementary material].

Classification of Cryptococcus neoformans and yeast-like fungus isolates from pigeon droppings by colony phenotyping and ITS genotyping and their seasonal variations in Korea

Cryptococcus neoformans (C neoformans) is a frequent cause of invasive fungal disease in immunocompromised human hosts. Ninety-eight samples of pigeon droppings were collected from the pigeon shelters in Seoul, and cultured on birdseed agar (BSA) and Sabouraud dextrose agar (SDA). One hundred yeast-like colonies were selected and identified via phenotype characteristics, such as colony morphology and biochemical characteristics. This was then followed with genotyping via sequencing of the internal transcribed spacer (ITS) region. The colonies were classified into four kinds of colony color types: brown type (BrT), beige type (BeT), pink type (PT), and white type (WT). Numbers of isolated BrT, BeT, PT, and WT colonies were 22 (22%), 30 (30%), 19 (19%), and 39 (39%), respectively. All BrT colonies were identified as C neoformans. BeT were identified as 19 isolates of Cryptococcus laurentii, 10 isolates of Malassezia furfur, and 1 isolate of Cryptococcus uniguttulatus. PT was divided into two colony color types: light-PT (l-PT) and deep-PT (d-PT). Eighteen of l-PT and one of d-PT were identified as Rhodotorula glutinis and Rhodotorula mucilaginosa, respectively. WT were identified as 34 isolates of Cryptococcus guilliermondii, 3 isolates of Cryptococcus zeylanoides, 1 isolate of Cryptococcus sake, and 1 isolate of Stephanoascus ciferrii. Most strains were classified identically with the use of either phenotype or genotyping techniques, but C uniguttulatus and C sake classified by phenotyping were Pseudozyma aphidis and Cryptococcus famata by genotyping. This rapid screening technique of pathogenic yeast-like fungi by only colony characteristics is also expected to be very useful for primary yeast screening. Additionally, we investigated the seasonal variations of C neoformans and other yeast-like fungi from 379 pigeon-dropping samples that were collected from February 2011 to March 2011. We isolated 685 yeast-like fungi from the samples. Almost all C neoformans and yeast-like fungi were isolated in the fall (298 strains, 43.5%) and spring (244 strains, 35.6%). A few yeast-like fungi were isolated in winter (98 strains, 14.3%) and summer (45 strains, 6%). These results would be used as an important indicator related to epidemiology and prevention of pathogenic yeast-like fungi infections transmitted through pigeon droppings.

Colloid coalescence with focused x rays

We show direct evidence that focused x rays enable us to merge polymer colloidal particles at room temperature. This phenomenon is ascribed to the photochemical scission of colloids with x rays, reducing the molecular weight, glass transition temperature, surface tension, and viscosity of colloids. The observation of the neck bridge growth with time shows that the x-ray-induced colloid coalescence is analogous to viscoelastic coalescence. This finding suggests a feasible protocol of photonic nanofabrication by sintering or welding of polymers, without thermal damage, using x-ray photonics.

Accessory polar renal artery encountered in transperitoneal systemic laparoscopic paraaortic lymphadenectomy

OBJECTIVE

To increase vigilance among gynecological surgeons for the presence of accessory polar renal artery (APRA) encountered with transperitoneal systemic laparoscopic paraaortic lymphadenectomy (LPAL).

METHODS

A retrospective review was conducted on 156 women who underwent LPAL for various gynecologic malignancies between November 2003 and December 2009.

RESULTS

The median age, parity, body mass index, and number of previous abdominal surgeries, respectively, of the women were 52 years (range, 23-82 years), two (range, 0-7), 24.1 kg/m2 (range, 17.4-35.0 kg/m2), and 0 (range, 0-3). During the study period, we found four women with APRA. There were three cases of right lower APRAs arising from the abdominal aorta, caudal to the inferior mesenteric artery (IMA), terminating at the parenchyma of the lower pole of the right kidney. In the other case, the APRA arose from the abdominal aorta superior to the IMA. There were no vascular complications, such as transection or ligation of the APRA.

CONCLUSION

It is important for the gynecological oncologic surgeon to have knowledge of retroperitoneal vascular anatomy, experience in laparoscopic surgery, and an accurate surgical technique to avoid vascular injury during LPAL.

Submitral left ventricular aneurysm of ischemic origin: report of two surgical cases

Submitral left ventricular aneurysm has been exclusively recognized in the young African population and its occurrence in other than black Africans is rarely reported. Here we describe two surgical cases of submitral left ventricular aneurysm in Asian elderly persons. Although the aneurysms were typically located beneath the posterior mitral valve leaflet, we could identify diseased coronary arteries as well, unlike the reports in the literature asserting that this type of aneurysm occurs in the absence of coronary disease. The possible racial difference with regard to the etiology is addressed.

CPAP of 10 cmH2O during cardiopulmonary bypass followed by an alveolar recruitment manoeuvre does not improve post-bypass oxygenation compared to a recruitment manoeuvre alone in children

This randomised controlled study assessed whether continuous positive airway pressure (CPAP) of 10 cmH2O during cardiopulmonary bypass improves post-bypass oxygenation in children compared with no CPAP during bypass. We studied children with a ventricular septal defect. CPAP of 10 cmH2O was applied during bypass in the CPAP group (n=24), whereas the lungs were left deflated in the control group (n=20). In both groups, an alveolar recruitment maneuver was performed by applying positive pressure of 30 to 40 cmH2O for five seconds before weaning from bypass. Postoperative ventilation had the peak inflation pressure set to produce an expired tidal volume of 8 ml/kg with positive end expiratory pressure of 5 cmH2O. Arterial blood gas and haemodynamic measurements were performed at skin incision, five minutes after weaning from bypass, five minutes after chest closure and four hours after arrival in the intensive care unit. In four children CPAP was discontinued because it adversely affected the operating field. There was no difference in demographic characteristics, haemodynamic data, bypass time and operation time. No difference was observed between the groups with respect to pH, PaO2, P(A-a) DO2, PaCO2, and ETCO2 at each time. Variability in the data was greater than expected, leading to a decrease in the expected power of the study. CPAP at 10 cmH2O during bypass was not found to improve the post-bypass oxygenation as compared with leaving the lung deflated during bypass in children undergoing ventricular septal defect repair who had an alveolar recruitment maneuver at the end of bypass.

The effect of grain boundaries inside the individual ZnO nanowires in gas sensing

We present the gas sensing characteristics of the individual ZnO nanowires with single-crystalline and multiple grain boundaries (GBs) fabricated using bottom-up and top-down approaches, respectively. The sensor response of the individual ZnO nanowires with the multiple GBs was enhanced approximately three times as compared to that of single-crystalline ZnO nanowires due to well-known GB modulations. However, the response and recovery times of the individual ZnO nanowires with multiple GBs were much slower than those of the single-crystalline ZnO nanowire, indicating the presence of oxygen diffusion resistance to GBs due to the relatively fast surface kinetic reaction. Simplified kinetic diffusion modeling and experimental results could quantify the significant diffusion resistance of gas molecules into the GBs of the individual ZnO nanowires.

The synthesis of single PdAu bimetallic nanowire: feasibility study for hydrogen sensing

Single PdAu bimetallic nanowires have been synthesized via the sequential processes of electrochemical deposition and dielectrophoresis (DEP). In the first step, Pd/Au grains on predefined Au electrodes were grown by electrochemical deposition and could assist effectively the formation of a single PdAu nanowire with a good directionality by the subsequent DEP process. The synthesized PdAu nanowires have an average of approximately 10 at.% of Pd, a good resistance of a few hundred Omega, diameters of 300 nm on average and lengths of up to 15 microm. Based on the single PdAu nanowire, hydrogen detection was demonstrated in the range from 100 to 2500 ppm.

Practical anatomic landmarks for determining the insertion depth of central venous catheter in paediatric patients

BACKGROUND

Various methods have been recommended to decide a proper insertion depth of central venous catheter (CVC). The carina is recommended as a useful target level for the CVC tip position. We evaluated the sternal head of a right clavicle and the nipples as anatomic landmarks for determining the optimal depth of CVC in paediatric patients.

METHODS

Ninety children, <5 yr, undergoing catheterization through the right internal jugular vein were enrolled. The insertion depth was determined as follows. The insertion point was designated as 'Point I'. The sternal head of the right clavicle was called 'Point A' and the midpoint of the perpendicular line drawn from Point A to the line connecting both nipples was called 'Point B'. The insertion depth of CVC was determined by adding the two distances (from I to A and from A to B) and subtracting 0.5 cm from this. A chest radiography was taken and the distance of the CVC tip from the carina level was measured by the Picture Archiving and Communicating System.

RESULTS

The mean distance of the CVC tip from the carina level was 0.1 (1.0) (P=0.293) cm above the carina (95% CI 0.1 cm below the carina-0.3 cm above the carina). There was no specific relationship between the distance of the CVC tip from the carina level and the patients' age, height, and weight.

CONCLUSIONS

The CVC tip could be placed near the carina by using the external landmarks without any formulae, images, and devices in children in our study.

Identification of markers of cardiovascular disease in women and the reconstruction of its corresponding protein interaction network

Cardiovascular disease is the second most prevalent cause of morbidity and mortality in women of developed countries. Although it is well established that gender is a risk factor for cardiovascular disease, most gene expression analysis studies favour the identification of disease bio-markers and potential drug targets over combined populations. This study integrates genomic and systems approaches to identify a female-related set of genes that intervene in signal and metabolic pathways leading to cardiovascular disease.

Statistical evaluation of the cleft lip nose deformity image

Cleft lip is a congenital deformity condition with separation of the two sides of the lip and causes nose deformity. Evaluation of surgical corrections and assessment of prognosis in nose deformity depend mainly on doctor's subjective judgment. Development of an objective assessment tool in evaluation of the cleft lip nose deformity patients will help in advancement and evaluation of surgical techniques. Therefore, our study aimed on quantitative assessment of a cleft lip nose deformity by comparing following parameters gathered from a photographic image of a cleft lip patient: (1) angle difference between two nostril axes, (2) center of the nostril and distance between two centers, (3) overlapped area of two nostrils and (4) the overlapped area ratio of two nostrils. Assessment results of the nose deformity were statistically analyzed with evaluation results from three highly experienced plastic surgeons. In addition, regression model was developed using correlation relationship and factor analysis of parameters from the results of image analysis.

The study of beta-lactoglobulin adsorption on polyethersulfone thin film surface using QCM-D and AFM

The adsorption process of beta-lactoglobulin on the polyethersulfone-coated surface has been investigated using a quartz crystal microbalance with dissipation monitoring (QCM-D), which allowed simultaneous measurements of frequency and energy dissipation changes caused by the formation of a beta-lactoglobulin layer during the protein adsorption process. The results showed that the protein adsorption on the spin-coated polyethersulfone surface consisted of reversible and irreversible adsorption processes, and the irreversible adsorption was the principal factor to cause the permanent protein adsorption onto the polymer surface. The amount of irreversible adsorption of beta-lactoglobulin increased significantly, from 380.5 +/- 23.2 to 745.5 +/- 29.7 ng/cm2, when the concentration of beta-lactoglobulin solution varied from 0.1% to 2.0% (w/v). The pH also played an important role in the protein adsorption. When the pH of the solution varied from 7.0 to 3.0, the amount of irreversible adsorption of beta-lactoglobulin increased from 427.1 +/- 80.7 to 741.2 +/- 135.1 ng/cm2.

Alternative method for predicting optimal insertion depth of the laryngeal tube in children

BACKGROUND

Little information is available about the accuracy of the teeth mark on the laryngeal tube (LT) as a guide to correct placement in children. The aim of this crossover study was to evaluate three methods for optimal insertion depth of the size (#) 2 tube in children weighing 12-25 kg.

METHOD

In 24 children, the LT #2 was consecutively inserted by three different methods: (A) until the thick teeth mark on the tube was aligned with the upper incisors, (B) until resistance was felt, and (C) by inserting to a depth, previously measured, of the curved distance between the cricoid cartilage and the upper incisor. In each case, the depth of insertion, the degree of effective ventilation, the presence of leakage, and the fibreoptic view were assessed.

RESULTS

Insertion based on the teeth mark led to a shorter insertion depth and a greater incidence of inadequate ventilation compared with the other two methods. There was no difference in the adequacy of ventilation between methods B and C. The vocal cords were more easily identified with methods B (62.5%) and C (75%) than with method A (12.5%).

CONCLUSIONS

Insertion of the LT #2 aligned with the teeth mark can result in a shallow insertion depth and inadequate ventilation. The measured distance from the cricoid cartilage to the upper incisor offers alternative guidance for correct LT insertion.

Fulminant type 1 diabetes in Korea: high prevalence among patients with adult-onset type 1 diabetes

AIMS/HYPOTHESIS

The aim of this study was to investigate the prevalence of fulminant type 1 diabetes and the clinical characteristics of the disease among newly diagnosed Korean patients.

METHODS

Using data retrieved from the Seoul National University Hospital database, we identified all patients newly diagnosed with type 1 diabetes from 1 January 1999 to 31 July 2006. Information on clinical manifestations and laboratory data, including the presence of islet autoantibodies detected at diagnosis, were obtained by reviewing medical records.

RESULTS

We identified 99 patients newly diagnosed with type 1 diabetes. Seven patients (7.1%) fulfilled the criteria for fulminant type 1 diabetes. Among the patients aged > or =18 years at onset, 30.4% had fulminant type 1 diabetes. Patients with this diabetes subtype tested negative for islet autoantibodies, had a higher age of onset (median 28 vs 10 years, p < 0.001) and a markedly shorter duration from onset of hyperglycaemic symptoms to first hospital visit (median 3 vs 30 days, p < 0.001) than patients with non-fulminant type 1 diabetes, and showed trends of increased serum aspartate aminotransferase and amylase levels and a decreased glucagon-stimulated serum C-peptide response.

CONCLUSIONS/INTERPRETATION

In Korea, the prevalence of fulminant type 1 diabetes was 7.1% among all patients newly diagnosed with type 1 diabetes and 30.4% among patients with adult-onset diabetes. The clinical and metabolic characteristics of the patients with fulminant type 1 diabetes were similar to those reported in Japanese studies.

Subtyping of ischemic stroke based on vascular imaging: analysis of 1,167 acute, consecutive patients

Background and Purpose

Knowledge of a patient's cerebral vascular status is essential for accurately classifying stroke. However, vascular evaluations have been incomplete in previous studies, and a stroke registry based on the results of such vascular investigations has not been reported. The purpose of the present study was to classify ischemic strokes based on vascular imaging data.

Methods

Between May 2001 and August 2003, 1,264 patients with acute (< 7 days) ischemic stroke were admitted to Asan Medical Center. Among them, 1,167 patients (750 men and 417 women; mean age 63.3 years) underwent an angiogram (mostly a magnetic resonance angiogram) and were included in this study. Electrocardiography and computed tomography/magnetic resonance imaging were performed in all patients, while 31.2% underwent echocardiography. The subtypes were categorized with the aid of a modification of the Trial of ORG 10172 in the Acute Stroke Treatment classification.

Results

Large-artery atherosclerosis (LAA) was the most frequent subtype (42%), followed by small-vessel occlusion (SVO, 27%), cardiogenic embolism (CE, 15%), undetermined etiology (15%), and other determined etiology (1.5%). Risk factors included hypertension (71%), cigarette smoking (35%), diabetes mellitus (30%), history of previous stroke (22.7%), emboligenic cardiac diseases (20%), and hypercholesterolemia (11%). Hypertension was more common in patients with SVO than in those with other subtypes (p<0.05), and the case-fatality rate was higher in patients with CE than in those with other subtypes (p<0.01). The functional outcome was worse in patients with LAA than in those with other stroke subtypes (p<0.01).

Conclusion

According to the stroke registry based on vascular imaging results, LAA was the most common stroke subtype followed by SVD. The high incidence of LAA is probably related to the increased identification of the presence of intracranial atherosclerosis by MR angiogram.

Dissociation energies of molecular hydrogen and the hydrogen molecular ion

We have obtained improved values for the dissociation energies of molecular hydrogen and its ion by using a high-resolution pulse-amplified laser to probe the second dissociation limit. The onset of the vibrational continuum is observed by state-selective detection of the atomic products of dissociation, and several auxiliary measurements link the results to the ground state. The dissociation energies are accurate to 0.010-0.026 cm(-1), improving previous measurements by a factor of 3-7. Agreement with ab initio calculations is good for H2, D2, and their ions, but not for HD and HD+.

Domestic wastewater reclamation by submerged membrane bioreactor with high concentration powdered activated carbon for stream restoration

This study focuses on the practical application of high concentration powdered activated carbon coupled membrane bio-reactor to domestic wastewater reclamation. The study was conducted in three parts, such as analysis of secondary domestic wastewater effluent, design and operation parameter evaluation and reclaimed water quality estimation for stream restoration. The organic concentration was 25.2-80.2 mgCOD(Cr)/L for the effluent of three domestic wastewater treatment plants. Around 50-75% of the COD was low molecular substances less than 1,000 which were quite biodegradable. The sawdust PAC was estimated to be proper adsorbent for the organics in the secondary effluents. Its Freundlich constant, K value was 5.847 and 1/n, 0.36. Using a system consists of single reactor with high concentration PAC (80 g/L) and submerged hollow fiber MF membrane module with nominal pore size of 0.1 microm, design and operation parameters were obtained, such as HRT of the bioreactor (2.5 hr), PAC concentration (80 g/L), the initial flux (less than 0.5 m/day) and intermittent suction cycle (12 min. suction and 3 min. idling). Organic removal by the system was high enough to produce reclaimed water for urban stream restoration The effluent organic concentration was at the level of 2 mg/L in terms of TOC (around 5 mg/L as COD(Cr)). Substances with molecular weight cut off < 1,000 were removed mostly by adsorption and biodegradation. Those above 1,000 were rejected at PAC cake layer on the membrane and gradually degraded by microorganisms during extended contact.

Organic and detergent degradation in combined O3/UF for domestic laundry wastewater reclamation

This paper focuses on the evaluation of organic and detergent degradation in a combined Ozone/UF system for domestic laundry wastewater reclamation. Formation of by-product was investigated by GC/MS for the reclaimed water. Ozone was injected into the raw wastewater in a 10 L contact tank and the wastewater was circulated through the membrane module for inner pressurized cross-flow filtration. The concentrate was returned back to the contact tank. The membrane used in this experiment was hollow fiber polysulfone UF membrane with MWCO 10,000. It has an effective filtration area of 0.06 m2. The experiment was carried out with intermittent ozone injection, 5 min injection and 10 min idling. Ozone was dosed at the concentration of 1.5 mg/L. The flux of the UF could be maintained at 0.24 m/d under filtration pressure 40-45 kPa and water temperature, 20-22 degrees C. The organic removal efficiency by the system was 90% in terms of COD. Ozone was considerably effective to degrade organics in the wastewater. Molecular weight of organics in the raw waste was mostly greater than 10,000 (72% of 950 mgCOD/L). However 86% of effluent COD (94-100 mg/L) was composed of organics smaller than MWCO 500 by ozone injection. No harmful by-products by ozone contact were detected from the analysis of treated water using GC/MS. It was identified that residual organics in the treated water were 1,1'-Oxybisbenzene, Octadecanoic acid, Squalene and Benzenmethanol, etc., which were additives contained originally in the detergent. Consequently the reclaimed water quality could be estimated safe enough to recycle for the rinsing cycle in a washing machine.

Sputum eosinophilia in cough-variant asthma as a predictor of the subsequent development of classic asthma

BACKGROUND

A significant proportion of patients diagnosed with cough-variant asthma eventually manifest classic asthma signs, such as wheezing and dyspnoea. The aim of this study was to investigate whether the percentage of eosinophils and/or concentration of eosinophilic cationic protein (ECP) in sputum induced from patients with cough-variant asthma can predict the development of classic asthma.

METHODS

Sixty-two children with cough-variant asthma were prospectively studied for 4 years. At the initiation of the study, sputum was induced with hypertonic saline, and the sputum samples were analysed for total and differential cell counts, and for ECP. Each subject was checked clinically at least every 3 months, and details of classic asthma signs experienced during the intervening periods were taken.

RESULTS

Twenty-four (47.1%) of the 51 subjects available for follow-up developed signs of classic asthma, while 27 did not. The only significant difference in the sputum parameters between these two groups was a higher percentage of sputum eosinophils in subjects who developed classic asthma. A significant association was found between sputum eosinophil percentage and classic asthma development, but not between the concentration of sputum ECP and classic asthma development.

CONCLUSION

Sputum eosinophilia in cough-variant asthma may be a correlate of the later development of classic asthma. This suggests that sputum differential cell counts may be useful in the clinical management of patients with cough-variant asthma, as they may enable the prediction of the subsequent classic asthma development.

Total synthesis of microtubule-stabilizing agent (-)-laulimalide

An enantioselective first total synthesis of laulimalide (1) is described. Laulimalide, a remarkably potent antitumor macrolide, has been isolated from the Indonesian sponge Hyattella sp. and the Okinawan sponge Fasciospongia rimosa. Laulimalide represents a new class of antitumor agents with significant clinical potential. The synthesis is convergent and involved the assembly of C(3)-C(16) segment 4 and C(17)-C(28) segment 5 by Julia olefination. The sensitive C(2)-C(3) cis-olefin functionality was installed by Yamaguchi macrolactonization of a hydroxy alkynic acid followed by hydrogenation of the resulting alkynoic lactone over Lindlar's catalyst. Initial attempts of intramolecular Still's variant of Horner-Emmons olefination between the C(19)-phosphonocetate and C(3)-aldehyde provided a 1:2 mixture of cis- and trans-macrolactones. The trans-isomer was photoisomerized to a mixture of cis- and trans-isomers. The other key steps involved ring-closing olefin metathesis to construct both dihydropyran units, stereoselective anomeric alkylation to functionalize the dihydropyran ring, stereoselective reduction of the resulting alkynyl ketone to set the C(20)-hydroxyl stereochemistry, and a novel Julia olefination protocol for the installation of the C(13)-exo-methylene unit. The sensitive epoxide at C(16)-C(17) was introduced in a highly stereoselective manner by Sharpless epoxidation at the final stage of the synthesis.

Cecal rupture by Anoplocephala perfoliata infection in a thoroughbred horse in Seoul Race Park, South Korea

A 7-year-old Thoroughbred horse was admitted to the Equine Hospital, Korea Racing Association with signs of colic. Based on the size of impactions, the clinical signs, the results of abdominal paracentesis and medical treatment, the prognosis was poor. The horse died 3 hours later following hopeless discharge. At necropsy, the caecum and large colon were fully filled with fecal contents and there was a rupture (10 cm in dia) in the latero- ventral caecum. The mucosa of the ileo-caecal and caeco- colic valves appeared to the hyperemic, edematous and ulcerous. There were many tapeworms in the affected mucosa. Histopathologically, lesions included hyperaemia, a deep necrotic inflammatory lesion and ulcers in the mucosa and submucosa of ileo-caecal and caeco-colic valves. One hundred thirty four faecal samples were obtained from 16 stables and submitted to parasitic examination. A total of 4 genera of eggs were recovered: Stongylus spp (82.1%), Anoplocephala perfoliata (10.5%), Bovicola equi (0.7%) and Parascaris equorum (1.5%). The major findings in this study are the presence of A perfoliata and its suspected association with the colic which led into an eventual caecal rupture. This study indicates the needs for an epidemiological survey of colic that is associated with Anoplocephala.

Expression of vascular endothelial growth factor and inducible nitric oxide synthase in pterygia

PURPOSE

To evaluate the expression of vascular endothelial growth factor (VEGF) in pterygium and investigate the interrelationships between VEGF and nitric oxide (NO) in the development of pterygia.

METHODS

Specimens of normal conjunctiva acquired incidentally to conjunctival transplantation during pterygium and strabismus surgery and the excised pterygium were used in this study. Cryopreserved tissue specimens consisting of normal conjunctiva and pterygium were used to study the expression of VEGF and inducible NO synthetase (iNOS), using immunohistochemistry. For confirmation of NOS activity, reduced nicotinamide adenine dinucleotide phosphate (NADPH) diaphorase staining was done. Enzyme-linked immunosorbent assay (ELISA) for detection and quantification of VEGF was performed.

RESULTS

Expression of VEGF and iNOS was strongly revealed mainly in the epithelium of the head portions of pterygial specimens, although not in the epithelium of conjunctival ones. Pterygial epithelium was stained with NADPH diaphorase, confirming NOS activity. ELISA showed a greater amount of VEGF in pterygium (11.7 +/- 2.1 pg/mg) compared with normal conjunctiva (4 +/- 0.47 pg/mg) ( p < 0.05).

CONCLUSION

These data are the first to demonstrate that VEGF and NO may play an important role in the development of pterygium and to identify VEGF and NO in the epithelium of pterygium. We hypothesize that environmental stress, such as ultraviolet irradiation and local inflammation stimulate the elaboration of NO and VEGF, resulting in the conjunctival fibrovascular ingrowth characteristic of pterygium.

Classification and treatment of prominent mandibular angle

In Oriental culture, the contour of the mandibular angle is important for feminine facial shape because a woman who has a wide and square face is thought to have had an unhappy life. A prominent mandibular angle, which does not coincide with the natural look, produces a characteristic quadrangle, coarse, and muscular appearance. So Oriental women who have a prominent mandibular angle want to have an ovoid, reduced, and slender face by aesthetic mandibular angle resection. Many satisfactory corrections of a prominent mandibular angle by various operative techniques have been reported. But reasonable morphologic classification and treatment were not reported. So we classified prominent mandibular angles into four groups by morphology and operated on the patients according to their classification with different modalities: no square shape but only a reduced gonial angle in the profile view-class I, mild form; severe mandibular angle protrusion with lateral protrusion-class II, moderate form; a definite square-shaped angle (class II) with masseteric hypertrophy-class III, severe form; and combined prominent mandibular angle and chin deformity-class IV, complex form. We use angle ostectomy through the intraoral route alone or with an additional external stab incision for class I. An external stab incision to set up the reciprocating saw is sometimes helpful in class I cases because there is no lateral protrusion of the angle. For class II cases, we use conventional intraoral angle ostectomy only or angle splitting ostectomy with contouring. For class III cases, we use angle splitting ostectomy and contouring with partial masseteric myectomy. In class IV, we use angle ostectomy and additional genioplasty. During 7 years, we have performed 46 cases of mandibular angle resection. Of the mandibular angle resection cases, 19 were class I, 15 were class II, 9 were class III, and 3 were class IV. A total of 42 patients were satisfied with the postoperative results. For reasonable and satisfactory final results, classification according to the mandibular angle shape and suitable treatment according to the classification are essential.

Identification of Acanthocephala discovered in changran-pickles and myungran-pickles

To identify acanthocephala found in 'Changran-pickles' and 'Myungran-pickles' each organ was measured in permanent slides. In the present report, the results obtained were as follows: 1. Morphology of male worms: Worms possessed 18-19 longitudinal rows, with 4 hooks per row, which became smaller towards the base of proboscis. Each worm contained two testis and six cement glands arranged linearly. Body 22.0 by 0.8-0.6 mm and 15.0 by 0.6-0.4 mm, proboscis 284.8 by 227.6 micro m and 524.9 by 151.4 micro m, proboscis sheath 1570.7 by 72.7 micro m and 751.9 by 280.4 micro m, lemnisci length 2566.7 and 1085.6, testis 2202.9-1860.5 by 737.0-575.7 micro m and 1033.8-981.1 by 463.1-351.6 micro m, cement glands 940.2 by 441.2 micro m and 610.0 by 369.1 micro m. 2. Morphology of female worms: Worms possessed 14-18 longitudinal rows, with 6-10 hooks per row and become smaller toward the base of proboscis. Each worm contained an uterine bell and uterus in the posterior portion and the eggs filled the body cavity. Body, approximately 14.0 - 51.0 mm by 0.7-0.5 - 2.2-1.4 mm, proboscis 466.1-268.9 micro m by 259.9-252.0 micro m, proboscis sheath 1550.7-506.0 by 298.8-231.1 micro m, lemnisci length 1325.7-473.1 micro m, eggs approximately 112.4 by 28.5 micro m - 51.7 by 14.0 micro m. In this present study, the acanthocephala collected in 'Changran-pickles' and 'Myungran-pickles' were identified as Echinorhynchus gadi by morphological features.

Endoscopically assisted, intraorally approached corrective rhinoplasty

In the field of facial surgery, operations that require guesswork can result in unexpected complications. One example of such "blind" facial surgery is the lateral osteotomy procedure in corrective rhinoplasty. In most conventional corrective rhinoplasties, the postoperative results of a lateral osteotomy can be controlled by the surgeon's visual perception or manual dexterity; therefore, an experienced surgeon is indispensable in such elaborate operations. Until now, reports have focused on the endoscopic approach through the nasal dorsum or septum through the nostril. However, because of the difficulty in handling the endoscope with osteotomy instruments, it is considered difficult to perform a precise lateral osteotomy procedure using that approach. The authors think the intraoral endoscopic approach should be considered a viable alternative in corrective rhinoplasty. Through small, bilateral gingivobuccal incisions, both the piriform apertures and nasal bones can be easily exposed, and the exact level of the lateral osteotomy can be confirmed directly under the endoscope. The lateral osteotomy is made simply with a reciprocating saw, and symmetrical cutting can be ascertained during the operation. Sometimes, a particular osteotomy level or the proper repositioning of osteotomed segments can be readily evaluated with assistance from the endoscope during the operation. Eleven cases using this procedure were performed over the past 3 years. These endoscopic repairs for a deviated nose were quite helpful for visual confirmation and accurate correction. No complications occurred when using the endoscope with this procedure.

Cephalometric markers to consider in the treatment of Class II Division 1 malocclusion with the bionator

The principal aims of this study were to find the cephalometric predictors for good treatment results of bionator therapy and to justify bionator therapy as an early phase I treatment for patients with Class II Division 1 malocclusion. Forty subjects who had Class II Division 1 malocclusion and who were treated with the bionator were selected for this study. They were classified into a good treatment result group and a poor treatment result group in reference to the posttreatment molar relationship, posttreatment overbite and overjet, posttreatment profile, and existence of relapse. Thirty-one cephalometric variables were analyzed on the pretreatment lateral cephalograms by t-test to evaluate differences between the 2 groups. The variables that differed significantly were analyzed by discriminant analysis to assess their predictability. The study showed that horizontal growth pattern, close to normal anteroposterior relationship between the maxilla and mandible, upright mandibular incisor, and retrusive lower lip were important predictors for good results. In particular, protrusion of the lower lip was the most important factor for the determination of the treatment results. In addition, the treatment times were much shorter for patients with these good predictors. The present study supports the premise that bionator therapy can produce clinically stable and favorable results if the patients are appropriately selected with the use of these diagnostic criteria.

Different frequencies of electroacupuncture modified the cellular activity of serotonergic neurons in brainstem

In this study, we evaluated whether different frequencies of electroacupuncture (EA) modified the activities of serotonergic neurons in the dorsal raphe (DR) and raphe magnus (RMg) using double labeling immunohistochemistry for Fos and serotonin. The results demonstrated that both high and low frequency EA increased the colocalization between Fos and serotonin in the DR, not in RMg as compared with anesthesia control. In addition, high frequency EA more potently increased the serotonergic activity in the DR rather than low frequency EA, suggesting that serotonergic pathway from the DR plays an important role in the high frequency EA analgesia.

The thin latissimus dorsi perforator-based free flap for resurfacing

The authors present their experience with "thin" latissimus dorsi perforator-based free flaps for resurfacing defects. Perforator-based free flaps have been used for various kinds of reconstruction by presenting important donor structures. The thin latissimus dorsi perforatorbased free flap included only the skin and superficial adipose layer to reduce its bulkiness by dissection through the superficial fascial plane. This flap was used in 12 clinical cases, without flap necrosis or other serious postoperative complications. All of the patients were examined by preoperative power Doppler ultrasound in the spectral Doppler mode to search for the most reliable perforator. This noninvasive ultrasound technique determines the exact location and course of and ensures the reliable flow of the perforators; therefore, it greatly assists microsurgeons in saving operation time and in selecting the most suitable design for perforator flap reconstruction. We used perforators that were identified several centimeters from the lateral border of the latissimus dorsi muscle. The thin flap dimensions could be safely designed for flaps measuring up to 20 cm in length and 8 cm in width for primary closure of the donor site. Generally, a long pedicle is not required for resurfacing reconstructions, where small recipient arteries in the bed are acceptable for anastomosis with pedicles. However, pedicle dissection to the proximal vessels through the latissimus dorsi muscle was required when it was necessary to match the recipient vein for anastomosis. The authors conclude that this thin latissimus dorsi perforator-based free flap has great potential for resurfacing because of its constant thickness, easy elevation with the help of power Doppler ultrasound information, and proper flap size for moderate defects caused by scar contracture release, superficial tumor ablation, and so on.

Cloning and characterization of tissue inhibitor of metalloproteinase-3 (TIMP-3) from shark, Scyliorhinus torazame

We cloned the full-length cDNA encoding TIMP-3 from the cartilage of cloudy dogfish, Scyliorhinus torazame. The entire open reading frame was composed of 645 nucleotides and 214 residues including 12 conserved cysteines and asparagine-184, a putative site for N-linked sugars. It showed about 72% identity to those of other species based on the deduced amino acid sequence. The mRNA of shark TIMP-3 were expressed abundantly in brain and cartilage tissues. To investigate the roles of shark TIMP-3, an expression vector was constructed and transfected into HT1080 human fibrosarcoma cells. Overexpression of shark TIMP-3 reduced the activity of MMP-2 in gelatin zymography. Through human Alu PCR based CAM assay, we also confirmed that shark TIMP-3 transfected HT1080 cells had less intravasation effects.

Myositis ossificans of the chest wall simulating malignant neoplasm

Myositis ossificans originating from the chest wall is extremely rare. We report a case of myositis ossificans occurring in a young woman with progressive painful swelling in the chest wall. Preoperative examination suggested a malignant neoplasm originating from soft tissue. Although rare, myositis ossificans is one of the potential causes of painful swelling in the chest wall, and can be mistaken for a malignant neoplasm.

Management of persistent or recurrent pneumothorax with a two millimeter mini-videothoracoscope

The aim of this study was to assess whether a 2 mm mini-videothoracoscope could be used as a conventional videothoracoscope in the management of pneumothorax. Thirty patients of ages from 15 to 35 years with recurrent or persistent pneumothorax were involved in this study. The subjects consisted of 27 males and three females. The indications for videothoracoscopic surgery were ipsilateral recurrent pneumothorax in 12 (40%), persistent air leakage in 15 (50%), visible bullae in 2 (6%), and 1 bilateral pneumothorax (3%). The mean operation time was 42.9+/-12.9 min. The average number of uses for Endo-GIA was 1.9+/-1.3 times and chest tube indwelling time was 3.8+/-2.7 days. The average amount of keptoprofen (100 mg/2 mL/ampule) used on the first postoperative day was 1.2+/-1.1 ampules. No parenteral opioids were given to the patients for pain control after the procedures. After a follow up of 8 to 20 months, there was only one recurrence among the patients. In conclusion, a 2 mm videothoracoscope, in selective cases, can be successfully used as conventional videothoracoscope to manage persistent or recurrent pneumothorax with cosmetically excellent results.

A short history of MADS-box genes in plants

Evolutionary developmental genetics (evodevotics) is a novel scientific endeavor which assumes that changes in developmental control genes are a major aspect of evolutionary changes in morphology. Understanding the phylogeny of developmental control genes may thus help us to understand the evolution of plant and animal form. The principles of evodevotics are exemplified by outlining the role of MADS-box genes in the evolution of plant reproductive structures. In extant eudicotyledonous flowering plants, MADS-box genes act as homeotic selector genes determining floral organ identity and as floral meristem identity genes. By reviewing current knowledge about MADS-box genes in ferns, gymnosperms and different types of angiosperms, we demonstrate that the phylogeny of MADS-box genes was strongly correlated with the origin and evolution of plant reproductive structures such as ovules and flowers. It seems likely, therefore, that changes in MADS-box gene structure, expression and function have been a major cause for innovations in reproductive development during land plant evolution, such as seed, flower and fruit formation.

Descending necrotizing mediastinitis: mediastinal drainage with or without thoracotomy

Descending necrotizing mediastinitis (DNM) is a lethal process originating from odontogenic, pharyngeal, or cervical infections that descends along the fascial planes into the mediastinum. The surgical management ranges from cervical drainage to routine thoracotomy but remains controversial. We here describe two patients treated successfully who underwent cervical drainage alone or cervical drainage combined with thoracotomy. Wide cervical exploration with postural drainage was effective in one patient with limited DNM above the carina. Mediastinal exploration through thoracotomy was required to salvage the other with DNM extending below the carina and associated with pericardial invasion.

A DEF/GLO-like MADS-box gene from a gymnosperm: Pinus radiata contains an ortholog of angiosperm B class floral homeotic genes

The specification of floral organ identity during development depends on the function of a limited number of homeotic genes grouped into three classes: A, B, and C. Pairs of paralogous B class genes, such as DEF and GLO in Antirrhinum, and AP3 and PI in Arabidopsis, are required for establishing petal and stamen identity. To gain a better understanding of the evolutionary origin of petals and stamens, we have looked for orthologs of B class genes in conifers. Here we report cDNA cloning of PrDGL (Pinus radiata DEF/GLO-like gene) from radiata pine. We provide phylogenetic evidence that PrDGL is closely related to both DEF- and GLO-like genes of angiosperms, and is thus among the first putative orthologs of floral homeotic B function genes ever reported from a gymnosperm. Expression of PrDGL is restricted to the pollen strobili (male cones) and was not detected in female cones. PrDGL expression was first detected in emergent male cone primordia and persisted through the early stages of pollen cone bud differentiation. Based on the results of our phylogeny reconstructions and expression studies, we suggest that PrDGL could play a role in distinguishing between male (where expression is on) and female reproductive structures (where expression is off) in radiata pine. We speculate that this could be the general function of DEF/GLO-like genes in gymnosperms that may have been recruited for the distinction between stamens and carpels, the male and female reproductive organs of flowering plants, during the evolution of angiosperms out of gymnosperm-like ancestors.

MADS-box genes reveal that gnetophytes are more closely related to conifers than to flowering plants

The evolutionary origin of the angiosperms (flowering plants sensu stricto) is still enigmatic. Answers to the question of angiosperm origins are intimately connected to the identification of their sister group among extinct and extant taxa. Most phylogenetic analyses based on morphological data agree that among the groups of extant seed plants, the gnetophytes are the sister group of the angiosperms. According to this view, angiosperms and gnetophytes are the only extant members of a clade called "anthophytes" to emphasize their shared possession of flower-like reproductive structures. However, most phylogeny reconstructions based on molecular data so far did not support an anthophyte clade, but also could not clarify the case because support for alternative groupings has been weak or controversial. We have isolated 13 different homologs of MADS-type floral homeotic genes from the gnetophyte Gnetum gnemon. Five of these genes fall into monophyletic gene clades also comprising putatively orthologous genes from flowering plants and conifers, among them orthologs of floral homeotic B and C function genes. Within these clades the Gnetum genes always form distinct subclades together with the respective conifer genes, to the exclusion of the angiosperm genes. This provides strong molecular evidence for a sister-group relationship between gnetophytes and conifers, which is in contradiction to widely accepted interpretations of morphological data for almost a century. Our phylogeny reconstructions and the outcome of expression studies suggest that complex features such as flower-like reproductive structures and double-fertilization arose independently in gnetophytes and angiosperms.

Degeneration and transdifferentiation of human lens epithelial cells in nuclear and anterior polar cataracts

PURPOSE

To study the possible mechanisms of cataractogenesis by evaluating the characteristics of cataractous lens epithelial cells (LECs) in different types of human cataract.

SETTING

Kangnam St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.

METHODS

Lens epithelial cells attached to the anterior capsules in eyes with nuclear or anterior subcapsular were analyzed for morphological characteristics by electron microscopy and for cellular characteristics by immunohistochemistry.

RESULTS

Human LECs beneath the anterior capsule were degenerated in nuclear cataracts and were transdifferentiated in anterior polar cataracts. In senile nuclear cataractous lenses, LECs beneath the anterior capsule showed degenerative changes in morphology. In nuclear cataracts, LECs were immunohistochemically positive for cytokeratin and vimentin, while those in anterior polar cataracts were positive for vimentin only. The LECs of anterior subcapsular cataracts were transdifferentiated into spindle-shaped fibroblast-like cells without cellular junctions and embedded within a fibrillar meshwork mass. The extracellular matrixes in the anterior capsule of anterior subcapsular cataracts were immunohistochemically positive for fibronectin, laminin, collagen type I, and collagen type IV.

CONCLUSIONS

Lens epithelial cells in different types of cataracts have distinct cellular characteristics and may possess a bipotential nature with the ability to transdifferentiate into mesenchymal cells. This may be an underlying mechanism for the development of cataract and capsule opacification.